GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
OFFICE OF THE LIEUTENANT GOVERNOR 
DIVISION OF BANKING AND INSURANCE 
 
5049 Kongens Gade, St. Thomas, VI 00802-6487 • Tel: 340-774-7166 • Fax: 340-774-9458 
1131 King Street, Suite 101, Christiansted, VI 00820 • Tel: 340-773-6459 • Fax: 340-719-3801 
CLAIM OF ABANDONED PROPERTY 
(For Deceased Person) 
The Claim of Abandoned Property is made pursuant to Title 28, Chapter 29 Virgin Islands Code 
 
Name of Deceased: 
 
Last Address of Deceased:
 
 
Claimant’s Names:
 
 
Mailing Address of Claimant:  
 
Telephone Number: Home:  
Work: 
 
Other: 
 
 
 
 Name of Institution
 
 
Account No.: 
Safe Deposit Box No.: 
 
 
Policy No.: 
Certificate No.: 
 
Amount:
 
 
Description of Contents: 
 
 
The following documents are attached in support of this claim: 

 Passbook 

 Bank Certificate of Ownership 

 Certificate of Deposit 

 Death Certificate 

 Safe Deposit Receipt 

 Marriage Certificate 

 Picture I.D. 

 Birth Certificate 

 Affidavit of Lost Instrument
 Copy of Judicial determination, i.e., Probate Will, Order, Decree.
 
 
DATE: 
CLAIMANT’S SIGNATURE:  
 
Relationship to Deceased: 
 
For Office Use Only 
 
Listing No: 
 
Year: 
Page No.:  
 
 

The claim has been allowed 
The claim has been denied: 
In Whole/
In Part 
 
Director of Banking and Insurance 
On behalf of the Abandoned Property Administrator 
 
______________________________ 
Signature